This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Thursday, May 08, 2014

Pre - Budget Review Of The Health Sector - 8th May 2014.

As we head towards the Budget in Early to Mid-May 2014 I thought It would be useful to keep a closer eye than usual on what was being said regarding what we might see coming out of the Budget.

According to the Australian Parliament web site Budget Night will be on Tuesday 13th May, 2014.

Here are some of the more interesting articles I have spotted this week.

Budget in a bind if Joe Hockey and Tony Abbott are both serious

What a curious bind the government has managed to get itself into ahead of releasing the Commission of Audit's report on Thursday and its first budget tomorrow fortnight: on one hand the Treasurer been screaming "budget crisis" with an increasing note of urgency for the past year and more, but on the other, the Prime Minister keeps promising to keep his election promise not to surprise or disadvantage anyone or cut back on the most expensive programs of pensions, health and education.

Treasurer Hockey has promised that "everyone" will feel pain from his first budget. Last week he further stoked the fires of anticipation of a tough love budget, warming up the crowd with a little Commission of Audit preview ahead of the weekend's supposed leaks, inspired and otherwise, suggesting there will everything from a tax increase (but called a "levy") to a squeeze on stay-at-home spouses through scrapping Family Tax Benefit B.

Economics Editor, The Age

Over the next 40 years, the number of Australians aged 65 or over will double.

Is the cost of the pension really soaring beyond control? Or is that just the sort of talk we hear in the lead-up to every tough budget? Isn't the cost of superannuation growing even faster? And why all the talk about super and pensions after the Coalition won office promising no change to neither?

IS THE PENSION THE CAUSE OF JOE HOCKEY’S BUDGET WOES?

It doesn’t help. At present, the age pension accounts for 9.6 per cent of government payments. It is expected to climb to 10.6 per cent over the next four years but, after that, the Commission of Audit says it’ll stay steady at 10.6 per cent for the rest of the next decade.

Economics Editor, The Age

A few years back a Canberra man stole tens of thousands of dollar coins from the Royal Australian Mint. He worked there. He smuggled them out in his shoes and lunchbox.

How much easier would it be to spirit away coins if you owned the mint and ran it?

Owning and running the mint is now a real prospect for anyone who’s keen on money. The Commission of Audit wants it privatised after 2016.

It’s easy to imagine the worst. The mint can churn out up to 10 million coins a week. The new owner might get a request from the government for 7 million and churn out a few million extra. They could leave through the loading dock. There would no need to pack them into shoes.

Political correspondent

Australians born after 1965 will have to work until they are 70 before they are eligible for the age pension, Treasurer Joe Hockey has announced, as he warned there was "no such thing" as a free visit to a doctor or free welfare.

Mr Hockey confirmed on Friday that while nobody currently on the pension would be hit by a rise in the pension age, the Abbott government would raise the retirement age in coming years.

The Treasurer called on the Labor opposition to offer bipartisan support for the move.

In what is expected to be his final major speech before handing down his first federal budget on May 13, Mr Hockey said the Coalition would deliver a document that is "not going to be an austerity budget, but it is going to be a prudent budget" which would prepare Australia for the demographic challenges posed by an ageing population.

FORMER prime minister Kevin Rudd threatened to take over the public hospital system but ended up with reforms that “over-complicated” the health system, audit commission chairman Tony Shepherd said yesterday.

Mr Shepherd said the audit commission had examined the system in great detail and recommended giving the states more responsibility and authority so they could “just get on with the job’’.

“I think again we just get back to this fundamental thing — the states provide the hospital services, the commonwealth assists with some capital injection.’’

While the commission recommends Health Minister Peter Dutton develop his own blueprint for reform over the next 12 months, it backed the work of Labor’s National Health and Hospitals Reform Commission and said one option was to move to universal health insurance.

Noel Whittaker

The eligibility age, assets and income are in the Federal government's sights.

Australia is between a rock and a hard place. Rising life expectancies mean our present age pension system is unsustainable, yet any attempt to change it will be met with strong resistance from the over 65s - the fastest growing group in the community.

The present income and asset tests are generous. A homeowning couple can have assets of about $1,126,000, plus their home, before losing eligibility to at least a part pension under the assets test. For the income test, the cut off for a couple is $73,247 a year.

It's hard to make an argument that people whose assets and income are in range of these figures should be receiving assistance from the government. Expect to see the limits reduced - the big question is when.

The possibility of raising the pensionable age even further is making headlines and on first glance it would appear an easy option. It would have no impact on today's retirees and the government tells us how many billions of dollars would be saved in years to come.

The federal budget is Australia’s social compact with itself – as a nation, we raise taxes on companies and workers to spend on subsidies for the young, the old, the sick and the poor.

If we do that job well, then we are all better off. But typically we don’t do it well. Bismarck is often said to have remarked that you should never watch either laws or sausages being made, so perhaps it is no surprise that at any given time the budget is not the carefully thought-out masterpiece of good governance that you might hope.

Rather, it is the leftover mess resulting from coincidence, compromise and convenience.

THE only excuse for a deficit levy is that the pain of the government’s spending cuts would otherwise be focused overwhelmingly on the poor.

The $100,000 a year threshold, which Tony Abbott appears to be marking out as the upper limit for receipt of benefit payments, includes millions of households for whom government payments currently represent a significant share of their income.

For example, a family with one parent earning $65,000 and another earning $35,000, with three children under the age of 10, would be receiving about $8000 a year in family benefits at present, the loss of which would be a significant blow.

The details of just what the government is proposing will emerge with the budget, but the Prime Minister’s speech last night has made it clear that eligibility and indexation will be tightened across most government transfer payments.

The National Commission of Audit report released by the Abbott government today recommends a wave of public sector cuts including abolition and merger of key health agencies.

The report recommends that two health agencies – the Health and Hospitals Fund Advisory Board and the Anti-Doping research panel – be abolished outright, that twelve more be merged into other bodies and a range of others consolidated under further arrangements.

The report argues that various benefits would accrue from the sweeping reforms. It claims that embedding health and medical research within the health system would improve patient outcomes and deliver efficiencies; and improved data collection and analysis would result from reducing the number of agencies collecting data and reporting on health outcomes.

Croakey readers will no doubt be aware of the sweeping changes to health, welfare and other services that have been proposed by the Federal Government’s Commission of Audit, including an end to universal health care and a much tougher GP (and Emergency Departments) co-payment scheme than previously touted.

Further on health, it recommends “requiring” high income earners to take out private cover, and dropping the rebate that encourages them now, plus deregulating private health insurance so health funds can charge people for certain “lifestyle factors”, such as smoking, and allowing pharmacists to set up in supermarkets.

Released today, two months after it was handed to Treasurer Joe Hockey, the Commission’s report also recommends huge changes to other benefits and services in Australia, including a slower rollout of the National Disability, scrapping the Family Tax Benefit Part B payment, and forcing young job seekers to move to better employment areas.

This post compiles further reaction to health related recommendations of the National Commission of Audit, whose report to the Federal Government was released yesterday.

First up is an impassioned response from Tim Woodruff, vice president of the Doctors Reform Society, on expansion of private health insurance and the proposals to impose a $15 GP co-payment and to increase the costs of prescriptions.

These co-payments are killers. But they won’t stop politicians, newspaper proprietors, CEOs, or mining magnates getting whatever care they want or need. This is a recommendation to return to class warfare, to beat the weak and reward the rich. These are cruel and heartless recommendations designed to get Aussie battlers to do the heavy lifting whilst the wealthy complain about the cost of good home help.

Jonathan Swan and Fergus Hunter

Health Minister Peter Dutton has misled Australians with exaggerated claims about the unsustainability of the healthcare system, say economists and public health experts.

Contrary to claims by Mr Dutton, four health and economics experts interviewed by Fairfax Media said there was little evidence that Australia's healthcare costs were unsustainable.

And patient advocates warned the adoption of the National Commission of Audit's recommendations – including compulsory fees for doctor visits, emergency hospital charges and relegation of Medicare to only the needy – would bring about the end of universal healthcare.

THE health recommendations proposed by the Abbot government’s Commission of Audit would put health, medical and pharmaceutical care out of reach of families, says the Australian Medical Association (AMA).

The association’s president Steve Hambleton says the commission’s proposed health system undermines the principle of universal access to health care.

“It is clear that the commission’s recommendations have been put forward by business leaders and bureaucrats with no input from people with health and medical expertise,” Dr Hambleton says in a statement.

The Pharmacy Guild of Australia has swiftly rejected the recommendations of the National Commission of Audit in relation to community pharmacy and the PBS, referring to the document as an “attack” on pharmacy.

In a statement, the Guild said the Commission’s recommendations were “glaringly bad”, a “litany of economic rationalist ideas”, and that targeting existing pharmacy regulation would “destroy a system which enjoys the overwhelming support of Australian consumers”.

The Commission of Audit report, released yesterday, outlines a number of proposed changes to pharmacy regulation in Australia, including ownership and location rules.

The National Commission of Audit has made 86 recommendations with a focus on the federal government’s 15 biggest and fastest-growing areas of spending. Health is near the top of the list, with the Commission recommending sweeping changes such as a slew of co-payments and a delayed roll-out of the NDIS.

Health Editor, Sydney Morning Herald

Lives would be put at risk by "radical" National Commission of Audit reforms to Australia's health system that would begin an Americanisation of Australia's health system, furious doctors say.

They have warned the Abbott government not to go ahead with proposals such as compulsory fees for visiting the doctor, which they say would lead to a massive worsening of the burden of chronic disease in Australia.

They have described other proposals, such as asking busy hospital emergency departments to charge fees, as "fantasies" that could not possibly work.

GP Co-payments.

THE National Commission of Audit has sensationally recommended a $15 co-payment for GP visits and Medicare services.

The commission's report, containing 86 recommendations aimed at saving the budget up to $70 billion annually, was released in Canberra on this afternoon.

The big savings focus on health, the ageing and education.

Recommendations also include lifting the pension age to 70 by 2053, increasing the superannuation preservation age to 62 by 2027, slowing the rollout of the National Disability Insurance Scheme, and requiring high-income earners to take out private health insurance.

Communications and education correspondent

Labor's shadow assistant treasurer Andrew Leigh was once a strong supporter of a compulsory fee for visits to the doctor - a policy now slammed by the opposition as a “GP tax” that would hurt the community’s most vulnerable.

The Abbott government is expected to introduce a $6 Medicare co-payment for bulk-billed GP visits in the May budget, capped at 12 visits a year, in a bid to save $750 million over four years. The idea is opposed by Labor, the Australian Medical Association and other health groups, who say a fee would deter poor patients from seeking treatment.

Medicare Locals.

Medicare Local says new initiatives underway to help ease the burden on public hospital emergency departments on the New South Wales Central Coast are saving money and improving the standard of patient care.

A free mobile x-ray service, which has been available to aged care residents over the past 12 months, has seen 92% of patients avoid being transferred to hospital.

There has also been direct savings of almost $1.5 million dollars.

Central Coast Medicare Local's Chief Executive, Richard Nankervis says another trial, which gives ambulance paramedics the option of transferring patients to their GP rather than hospital is also proving successful.

Uncertainty about the future of Medicare Locals must be having a negative impact upon those involved with these organisations as well as those using their services. At least one Medicare Local (Country North SA) has felt the need to reassure its community that it is still open for business.

In the article below, Carol Bennett, CEO of the Hunter Medicare Local, says there is strong evidence to support a continued investment in Medicare Locals.

“Unless we are prepared to invest in specialist primary care organisations like Medicare Locals, we risk leaving our children a health legacy that may mean their life expectancy is less than ours,” she says.

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Pharmacy.

The Federal Government needs to consider the bigger picture when looking at further PBS cuts, pharmacy leaders are warning, saying a number of other mooted health budget cuts may already impact medicines expenditure.

The flow-on impact of policies like the GP co-payment will most likely lead to reductions in PBS levels anyway, says Anthony Tassone (pictured), president, Pharmacy Guild of Australia (Victoria).

“There’s lots of speculation of what’s going to happen in the Budget, but the government does need to be mindful that other policies, such as the GP co-payment, will already affect PBS growth as there is no doubt it will lead to a reduction in GP visits, and a reduction in scripts.”

A recent survey conducted by the Pharmacy Guild of Australia has found a “disturbing collapse in business confidence” among pharmacy owners, as a result of increasing pressure on revenue from PBS cutbacks.

A quarter of respondents to the Pharmacy Services Expectations Survey said they would reduce their opening hours over the upcoming financial year by an average of 5.4 hours a week. In addition, one in ten pharmacies will drop at least one trading day per week.

The survey of 548 pharmacies found that pharmacists were concerned about their ability to continue offering a full range of health services to their clients.

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Comment:

The drumbeat suggesting a tough budget continues to build. The final report of the Commission of Audit (COA) has been handed to Government and released with a lot of possible impacts on health.

We already know for certain the pension age will be 70 by 2035.

The new idea to scare the public this week is a so called‘debt levy’ - read income tax increase. The political fallout with this idea seems likely to be intense if the News Limited press over last weekend can be believed.

Interesting to see Community Pharmacy is really in the COA gun.

To remind people there is also a great deal of useful discussion here from The Conversation.